Does the Letter Matter (and for Everyone)? - Quasi-experimental Evidence on the Eff ects of Home Invitation on Mammography Uptake

We exploit regional variation in the availability of breast cancer screening policies and variations in age eligibility criteria across European regions to estimate the causal effect of home invitation on mammography uptake. We link administrative public data about regional breast cancer screening policies from various sources to individual Survey of Health Ageing and Retirement in Europe (SHARE) data. We find that home invitation increases mammography uptakes by almost 20 percentage points. At the same time, we find that home invitation reduces education-related inequalities but increases gradient in the use related to cognitive functions. In addition, significant effects on mammography use are found only when at least 50 per cent of the population is reached by the home invitation. Our results suggest that an exogenous informational shock affects preventive decisions especially among less informed individuals but the eff ectiveness of invitation is strongly reduced for women who are less able to process information.